Ⅳ期胃癌的外科治疗评价

Evaluation on surgical treatment for stage Ⅳ gastric carcinoma

目的 评价外科治疗对Ⅳ期胃癌的临床意义。方法 回顾性分析1993年4月至2004年12月外科治疗Ⅳ期胃癌患者200例，手术后随访时间为4-116个月，随访率为93．5％，用Kaplan-Meier进行生存曲线分析，LogRank进行生存曲线显著性检验。结果 本组手术切除率为80％，根治性切除105例，姑息性切除55例。淋巴结清扫范围D12例，D278例，D3及D3^＋26例。Ⅳ期胃癌患者的中位生存时间为（21．5±2．3）个月。根治性切除与姑息性切除者较仅行手术探查者的生存率明显提高。扩大淋巴结清扫范围可以提高术后生存率。局部因素P1H0T1-3N0-2,P0H1N0-2T1-3、T4N2-3、T1-3N3患者的生存时间明显长于全身因素P2-3、H2-3、P1-3，H1-3、TnNnM1的胃癌患者。对于P1H0T1-3N0-2、P0H1N0-2T1-3和T4N2-3,T1-3N3病例的根治性切除和联合脏器切除和D3淋巴结清扫，术后患者的生存时间明显长于行姑息性切除及手术探查、单纯切除以及D2淋巴结清扫的患者。结论对可以达到根治性切除的Ⅳ期胃癌进行根治性切除、D2以上淋巴结清扫和联合脏器切除可提高患者术后的生存率。

Objective To evaluate surgical therapy for stage Ⅳ gastric carcinoma. Methods Clinical data of 759 cases with gastric carcinoma from April 1993 to December 2004 were analyzed retrospectively. Among these 759 cases there were 200 cases （26.4%） in stage Ⅳ gastric carcinoma. Postoperative follow-up period varied between 4 - 116 months, the follow-up rate was 93.5%. Survival rate curves were analyzed by Kaplan-Meier method. Difference between survival rate curves was tested by Log Rank test. Results One hundred and sixty cases （80%） underwent tumor resection including radical resection in 105 cases （53.0%）, palliative resection in 55 cases （27.5%）. Lymph node dissection was ： Dl in 2 cases, Dz in 78 cases, D3 in 26 cases. Overall median survival was （ 21.5 ± 2. 3 ） months. Patients undergoing radical resection had a higher survival rate than that of palliative resection and laparotomy only. Extended lymph node dissection may increase the survival rate. Patients in P1H0T1-3N0-2, P0H1N0-2T1-3 ,T4N2-3 ,T1-3N3 had better survival than those in P2-3,H2-3,P1-3H1-3,TnNnM1. The survival time of patients in P1H0T1-3N0-2,P0H1N0-2T1-3,T4N2-3,T1-3N3 treated by radical resection and combined viscera excision and lymph node D3 dissection was longer than those treated by other surgical modalities. Conclusion Radical resection applied to stage Ⅳ gastric carcinoma patients in which the tumor is resectable fulfilling D2 lymphadenectomy and combined viscera excision when needed can improve postoperative survival rate.